To the Editor
The Center for Disease and Control has recommended that all hospitals adopt an infection control policy of “universal precautions”.(1) This policy assumes the blood and body fluids of all patients are infected with blood-borne pathogens and the health care workers should protect themselves with barrier devices. While the use of gloves in anesthesia is widespread, the use of a one way valve in the intravenous line to prevent patient blood into the drug line is not.
I have requested the manufacture of an intravenous line which is constructed with a one way valve inline between the patient and the first injection port. The intravenous fine is of concern because accidental needlesticks are an arm of continued problem in anesthesia personnel. For infection with human immunodeficiency virus type I (HIV 1), needlestick injuries carry the highest risk of transmission at 0.4 percent per incident but the estimate for the more prevalent hepatitis B virus (HBV) is 6 to 32 percent (2)
If the intravenous line utilized for injection of drugs is free of pathogens, the needlestick becomes a discomfort rather than an inoculation. The clean injection line will also preclude inoculation of other patients from contaminated needles and lessen the likelihood of contaminating multiple dose vials. The recommended use of the one way valve in the drug injection should be an additional safety feature for patients who are under the care of anesthesia personnel. This approach should also be used in the general hospital for the same reasons. It is a potential benefit for both health care professionals and patients. I suggest the placement of a one way valve in line before the injection port be universally adopted.
Paul J. Schaner, M.D. Mercy Hospital Pittsburgh, PA
- Centers for Disease Control: Recommendations for Prevention of HIV transmission in health care settings. MMWR 1987:36 (suppl 2S); 3S-18S
- Viahov, David et al.: Prevalence of Antibody of HIV-1 Among Entrants to US Correctional Facilities. JAMA 199 1; 265:1129-32.